The use of 18 F-FDG PET/CT to guide management of adrenal histoplasmosis over time
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The use of 18F-FDG PET/CT to guide management of adrenal histoplasmosis over time S. Parisien-La Salle 1
&
P. Morency-Potvin 2 & M. Lord 3 & F. Mercier 4 & B. P. Dubé 5 & C. Cohade 3,6 & I. Bourdeau 1
Received: 8 July 2020 / Accepted: 24 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
A 59-year-old female was referred for bilateral adrenal incidentalomas. CT scan demonstrated bilateral pulmonary opacities and multinodular adrenal glands measuring 4.2 × 1.7 cm (right) and 4.5 × 2.3 cm (left) with density > 10 Hounsfield units. 18F-FDG PET/CT revealed bilateral adrenal uptake (SUVmax 9.8 on the right (white arrow), 12.9 on the left (red arrow)) (a, b, c, d) that was significantly higher than the pulmonary opacities uptake (SUVmax 1.9). The patient reported fatigue and the recurrence of a mandibular mass that had been resected 2 years ago. Hormonal investigation revealed a primary adrenal insufficiency. Retrospectively, the pathology of the mandibular mass was compatible with histoplasmosis. Further investigations showed histoplasmosis in bronchoalveolar lavage and urine. Patient was treated with itraconazole based on imaging and mycology findings, and a multidisciplinary decision was made not to biopsy the adrenal glands. Immunodeficiency screening was negative for HIV.
This article is part of the Topical Collection on Endocrinology * I. Bourdeau [email protected] 1
Division of Endocrinology, Department of Medicine, Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
2
Division of Infectious Diseases, Department of Medicine, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
3
Department of Radiology, Radio-oncology and Nuclear Medicine, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
4
Surgical Oncology Service, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
5
Division of Respirology, Department of Medicine, Research Center, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Canada
6
Department of Radiology and Nuclear Medicine, Hôpital Maisonneuve-Rosemont, Montreal, Canada
Following 6 months of itraconazole, 18F-FDG PET/CT showed decreased adrenal uptake (SUVmax from 9.8 to 5.0 on the right and 12.9 to 4.3 on the left) (f, h). Moreover, the adrenal nodules had almost completely disappeared (e, g). This radiological improvement supported the diagnosis of adrenal histoplasmosis. Moreover, histoplasma antigen became negative. In contrast, some lung opacities were progressive, particularly a right upper lobe dominant ground glass opacity whose SUVmax progressed from 1.9 to 2.6 (black arrow) (i, j). Its biopsy demonstrated pulmonary adenocarcinoma. Most cases of adrenal histoplasmosis are diagnosed by adrenal biopsy [1, 2]. This case demonstrates a different management with the use of 18F-FDG PET/CT that supported the diagnosis of adrenal histoplasmosis showing radiological mass regression under antifung
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